CHEMOPREVENTION OF CANCERS INCREASING CONSUMPTION OF FLAVANOL-RICH COCOA

October is here and we all need to remind ourselves that it is marked by the global community as Breast Cancer Awareness month.

About 1 in 8 women are diagnosed with breast cancer during their lifetime, making this disease the most commonly occurring female cancer. Breast cancer remains a major cause of cancer mortality worldwide.

Breast cancer arises from mutations in breast cells, owing to complex interactions between lifestyle, reproductive and genetic risk factors. Increasing age, benign breast conditions, lifestyle (obesity, smoking, and alcohol), reproductive factors, and hormone exposure have been associated with increased breast cancer risk. About 5-10% of breast cancer cases owe to family history, and the most common cause of hereditary breast cancer is due to mutations in the BRCA1 or BRCA2 genes (BMC Medicine 2021).

About a third of cancers are preventable, another third can be effectively treated if seen early. There is still hope for the remaining third by way of palliative care. 

Diet is important at all stages of these steps. In the past few days, my daily posts on the health benefits of cocoa have focused on cancer. It is important to stress the antioxidant, anti-inflammatory, and antiproliferative effects of flavanol-rich cocoa and the prevention of cancer. 

I will at this point use extracts from a paper by Goya et al., titled “Effect of Cocoa and its Flavanols on Biomarkers of Inflammation: Studies of Cell Culture, Animals and Humans.” It is captured in Nutrients 2016, 8, 212; doi:3390/nu8040212. The material will be of benefit to many. 

Inflammation is a protective physiological response of body tissues to harmful stimuli, such

as pathogens, damaged cells, or irritants, that involves immune cells, blood vessels, and molecular mediators. The purpose of inflammation is to eliminate the initial cause of cell injury, clear outnecrotic cells and tissues damaged from the original insult and the inflammatory process, and initiatetissue repair. Although inflammation is normally closely regulated by the body, chronic inflammation may lead to a host of diseases, including the two most lethal pathologies of our time, cardiovascular disease and cancer.

Chronic inflammation has also been recognized as a relevant step in the onset and progressionof several types of cancer. During cancer progression, chronic inflammation is causally linked to carcinogenesis and acts as a driving force in the premalignant and malignant transformation ofcells.

The milestone for the process of chronic inflammation is an increase in the activity of the pro-inflammatory enzymes cyclo-oxygenase-2 (COX-2) and inducible nitric oxide (NO) synthase(iNOS) which creates a microenvironment contributing to the development of preneoplastic lesions.

The inflammatory microenvironment can increase mutation rates, in addition to enhancing the proliferation of mutated cells. Activated inflammatory cells are sources of reactive oxygen species (ROS) that are capable of inducing DNA damage and genomic instability. 

The inflammatory microenvironment is completed by pro-inflammatory cytokines produced by immune cells. Among these cytokines, the pro-tumorigenic function of (tumor necrosis factor (TNF-α) and interleukin 6 (IL-6) is well established.

The role of TNF-α and IL-6 as master regulators of tumor-associated inflammation and tumorigenesis makes them attractive targets for adjuvant treatment in cancer. Therefore, the use of chemopreventive compounds that suppress inflammation is a useful strategy to control the development and progression of several cancers.

There is increased focus on the identification of dietary compounds with anti-inflammatory bioactivity as an alternative natural source for the prevention of inflammation-associated diseases. Several studies have demonstrated that flavanols (sub-family of the flavonoid family of polyphenols) show the capacity to modulate inflammation, as well as other major metabolic and immunological pathways. The molecular mechanisms underlying their chemo-preventive effects have been associated with their antioxidant capacity, as well as the modulation of signaling cascades and expression of genes involved in the regulation of cell proliferation and apoptosis and the suppression of chronic inflammation.

Apoptosis is the death of cells that occurs as a normal and controlled part of an organism’s growth or development.

The capacity of flavanols to modulate signaling pathways involved in cellular processes such as inflammation, metabolism, proliferation, and apoptosis has encouraged research on this type of polyphenols as useful bioactive compounds for nutritional prevention of cardiovascular disease and cancer.

Flavanols or catechins are present in many fruits and vegetables, but mainly in tea, wine and cocoa. Cocoa is a rich source of antioxidants- out of the top 50 foods with the highest antioxidant capacity, five are found to be cocoa-based. Cocoa is a significant contributor to the total dietary intake of flavonoids. Cocoa contains high amounts of flavonoids catechin, anthocyanidins, and proanthocyanidins. There are minor quantities of other polyphenols such as quercetin, isoquercitrin (quercetin 3-O-glucoside), quercetin 3-O-arabinose, hyperoside (quercetin 3-O-galactoside), naringenin, luteolin and apigenin.

Cocoa powder is also a rich source of fiber (26%–40%), proteins (15%–20%), carbohydrates (about 15%), and lipids (10%–24%) and it contains minerals and vitamins. This makes it an excellent food for persons receiving palliative care.

Cocoa and derivatives, especially chocolate, are widely consumed worldwide, due to their highly attractive organoleptic characteristics. Cocoa products constitute a larger proportion of the diet of many individuals, than green tea, wine, or soybeans. The mean intake of catechins and procyanidins estimated for the USA is higher than the estimated intake of other flavonoids. Chocolate consumption contributed 2–5 mg of daily catechin intake out of an estimated total of 50 mg per day in a report from the Netherlands. It is estimated that cocoa products account for 10% of the total antioxidant capacity of Spanish dietary intake.It is important that in promoting the anti-cancer effects of cocoa emphasis is placed on the flavanol-rich cocoa-derived products.

Breast cancer is the most frequently diagnosed female cancer. It is important for primary prevention to include reducing modifiable risk factors such as obesity, sedentary lifestyle, and poor diet.Prevention of cancer through diet is receiving increasing interest. Cocoa because of its high polyphenol content is considered an important chemopreventive and therapeutic natural agent.

Flavanol-rich cocoa interferes with the initiation, promotion, and progression of cancer. Flavanol-richcocoa influences several important biological functions by their free radical scavenging ability and inhibits inflammation, cellular proliferation, apoptosis, angiogenesis, and metastasis. Angiogenesis is the growth of blood vessels from the existing vasculature. Decreasing or inhibiting angiogenesis can be therapeutic in cancer.

Initiation of the cancer formation is generally a slow process. This provides a window for chemoprevention. Chemoprevention is the use of specific natural (dietary) or synthetic agents to prevent, delay, or slow the initiation and formation of cancer (including breast cancer). Flavanol-rich cocoa is a notable chemopreventive agent- let us consume it daily as part of the fight against breast cancer.

BY DR. EDWARD O. AMPORFUL,CHIEF PHARMACIST,

COCOA CLINIC

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